Liver Metastasis of Low-risk Duodenal GIST Resected following Neoadjuvant Chemotherapy 20 Years:after Initial Resection —Report of a Case—

Abstract

The case involved a 63-year-old man who had undergone emergency partial duodenectomy for a duodenal tumor at the age of 43 (2001). On immunohistochemical examination, it was diagnosed as low-risk duodenal gastrointestinal stromal tumor (GIST). The patient who had been asymptomatic until recently was referred to our hospital in 2021 because an enlarged liver mass was found on abdominal computed tomography (CT) in a voluntary health screening. On our examinations, a mass 90-mm in diameter was found in the paracaval portion of the caudate lobe, compressing the portal vein, hepatic vein and inferior vena cava (IVC). A core needle biopsy revealed liver metastasis compatible with the duodenal GIST. We administered the doses of 400mg/day of imatinib for 5 months preoperatively on the concept of neoadjuvant chemotherapy. The tumor had shrunk by 39%. We performed left hepatectomy and caudate lobectomy with resection of the middle hepatic vein on a safe maneuver. The pathological diagnosis was compatible with liver metastasis from the duodenal GIST. We report a case of huge solitary liver metastasis in the paracaval portion 20 years after the resection for duodenal GIST.